White House AIDS policy director talks strategy in Chapel Hill

Feb. 21, 2013 @ 07:16 PM

Among a group of six men known as “the crew” that LeRoi Lattie used to hang out with in the 1980s in Washington, D.C., the Hillsborough native said he is the only one still living.

Lattie, who is living with HIV, or the human immunodeficiency virus, now works at the Lincoln Community Health Center Early Intervention Clinic to try to make sure people diagnosed with HIV get care.

“I question it – when I saw all the people around me dying – why me, or why not me,” said Lattie, who spoke Thursday at a meeting in Chapel Hill to discuss implementation of the White House’s HIV/AIDS strategy.

First announced in the summer of 2010, the federal initiative aims to cut down on new H.I.V. infections, to improve health outcomes for people living with the virus, to reduce HIV-related health disparities, and to have a more coordinated national response.

AIDS, which stands for acquired immunodeficiency syndrome, is caused by HIV, which destroys a type of blood cell in the body that’s needed to help fight disease.

According to the Centers for Disease Control and Prevention website, AIDS is the late stage of HIV infection when a person’s immune system is severely damaged, and has difficulty fighting disease and certain cancers. Because of medical advances, people can now live for decades with HIV before developing AIDS.

The White House HIV/AIDS initiative calls for new infections to be reduced by 25 percent by 2015, down to 42,225 infections. It also called for increased prevention efforts where HIV is heavily concentrated.

According to a 2011 report from the N.C. Communicable Disease Branch on HIV and sexually transmitted diseases, the estimated number of people living with HIV cases diagnosed and reported in the state was 26,168 as of Dec. 31 of 2011. In the year, there were 1,563 new diagnoses of HIV disease.

Evelyn Foust, director of the N.C. Division of Public Health Communicable Disease Branch, said there are also about 7,000 people in the state who are unaware that they’re infected.

Durham County had one of top five average rates in the state for the number of HIV disease diagnoses in 2009-2011, with a rate of 29.9 per 100,000 people, according to the report. The county was fourth behind Edgecombe, Mecklenburg and Wilson.

 “We know that treatment is prevention, and prevention is treatment,” she said. “It’s not simple because people in North Carolina have real lives and they have real challenges,” she added. “One of the biggest barriers since the ’80s is transportation.”

Grant Colfax, director of the White House’s national AIDS policy, said there is a drop-off in the percentage of people who are diagnosed and linked to care, and between those who get continued access to care and have viral suppression. He said black men who have sex with men are less likely to have health insurance coverage than white men who have sex with men, and are less likely to have HIV suppression.

He highlighted aspects of federal health care reform, stating that the law is expected to extend health insurance coverage to “tens of thousands” of people living with HIV. In 2014, there will be no denial of coverage for pre-existing conditions, including HIV. He also spoke of Medicaid expansion, saying HIV is a “a disease of poverty” and this is “transformative.”

Michelle Ogle, clinical director of the Warren Vance Community Health Center in Henderson, spoke at the meeting of concerns about a bill that has passed the N.C. House that would block the Medicaid expansion in the state.

Gov. Pat McCrory also released a statement recently announcing his opposition to Medicaid expansion.

Ogle said about 40 percent of the center’s patients are uninsured. She said the proposed legislation would be “devastating to our population.” She said she believes the Medicaid expansion would help cover the working poor, and would allow for greater detection and early treatment for people with HIV.

Dr. Ronald O. Valdiserri, deputy assistant secretary for health and the director of the U.S. Department of Health and Human Services’ Office of HIV/AIDS and Infectious Disease Policy, said there are discussions about how the Ryan White Program funding “will evolve” and how that change will be different in states that do expand their Medicaid programs, versus states that do not. The program aims to fill in funding gaps for people with HIV.

“It’s not like that’s been worked out, but obviously folks are aware of the issue, and I think where we can come at it as individuals who are concerned bout HIV/AIDS is to focus on what we consider to be the minimum level of quality that everyone in the United States who’s living with HIV/AIDS, care that they should be receiving,” he said.